Beyond Full Weight-Bearing Alone: Innovative, Individualized and Holistic Rehabilitation in Geriatric Orthopedic Trauma

Dear Colleagues,

Rehabilitation after geriatric trauma remains insufficiently individualized despite the growing complexity of the orthogeriatric patient population. Full weight-bearing is often considered the default postoperative strategy, although this does not always reflect the realities of older adults recovering from fractures and surgery. Some patients may be able to comply with partial weight-bearing instructions without adverse consequences, whereas others, from a surgical perspective, may be better advised to avoid full weight-bearing until fracture healing has occurred, particularly in the case of multi-fragmentary fractures and severely impaired bone quality. Furthermore, it may not always be beneficial to choose more invasive operative techniques and/or more complex implants solely to permit immediate full weight-bearing, especially if such strategies are associated with increased surgical morbidity in frail older patients. At the same time, adherence to prescribed postoperative loading recommendations in routine clinical practice remains unclear, particularly after hospital discharge. It is, therefore, uncertain to what extent recommended weight-bearing protocols, whether involving restricted or full loading, are actually followed outside the supervised inpatient setting. Moreover, patients with frailty, sarcopenia, multimorbidity, cognitive impairment, pain, reduced physiological reserve, poor adherence potential, or limited loading capacity often require rehabilitation concepts that go beyond routine mobilization algorithms.

This Special Issue aims to provide a platform for innovative, evidence-based rehabilitation concepts in geriatric trauma care. It focuses on individualized, multimodal, and patient-centered aftercare pathways, including rehabilitation under restricted or delayed weight-bearing conditions, strategies for patients unable to comply with partial weight-bearing prescriptions, and supportive approaches such as wearable monitoring, digital tools, robotics, electrical stimulation, and interdisciplinary orthogeriatric care. Contributions should remain clearly centered on rehabilitation in geriatric trauma and on outcomes such as mobility, autonomy, quality of life, and long-term functional recovery.

This Special Issue seeks to move the field beyond standardized postoperative instructions and toward precision rehabilitation that is better aligned with the needs and recovery potential of older trauma patients.

Prof. Dr. Johannes Dominik Bastian
Guest Editor

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